While promising vaccines and experimental treatments are rapidly being added to our arsenal, they’re not much use if people are too afraid to seek care.
By Karin Huster, Clinical Instructor, UW Department of Global Health and field coordinator with Doctors Without Borders.
BENI, Democratic Republic of Congo — A young mother stepped out of the ambulance into the triage area of our Ebola Transit Center, here in the northeast of the country. She moved slowly, careful not to wake the sick baby, swathed in layers of linens, that she carried in her arms. They had been brought here for testing because health workers suspected the baby might have Ebola.
We are six months into this latest Ebola outbreak. It is the worst on record for the Democratic Republic of Congo, and the second largest ever, after the 2014-2016 epidemic in West Africa. We’ve come a long way since then. An estimated $60 million is being allotted for this outbreak, and most patients can now expect to receive one of four experimental drugs as part of their treatment regimen. There is also a promising vaccine that is used to protect those most at risk of contracting the disease, like health care workers and people who have come into contact with the ill. And yet Ebola continues to find new people to infect.
According to the Congolese Ministry of Health, as of Jan. 29, there had been 743 reported cases and 461 deaths — a 62 percent mortality rate. There were 14 new cases last Wednesday alone. Six of them died at home, without having been to any Ebola treatment center.
That day when the mother and baby came to our center, I was standing on the other side of a fence that isolates the possibly contagious from the rest of us. I watched the young mother for a while, but I couldn’t catch her gaze. She appeared lost in her thoughts.
We were all waiting on the medical team to see what was wrong with the baby. But moving, with Ebola, is frustratingly slow. Doctors and nurses must wear “Ebola armor” — plastic boots, two pairs of gloves, a face mask, goggles, a full-body impermeable plastic suit and a thick plastic apron. Because it’s as hot as a sauna inside it, they can’t wear the protective gear for very long. So every time a new patient arrives, a new team has to suit up.
To partly remedy the problem, we are lucky to employ Ebola survivors to help in the triage area. Thanks to their acquired immunity to Ebola, they need much lighter protection, and so can be with patients much longer. They are the ones who spend the most time with patients as they are isolated for the three days it takes for testing. They are the ones who take care of the children and the babies who have to be separated from their mothers for this period.
If the patients don’t have Ebola, they get to go home or to the hospital for further medical care. If they test positive, they will be transferred to the Ebola Treatment Unit just down the street, where they could remain isolated for weeks.
Unlike us, unrecognizable in our scary spacesuits, survivors put a human touch to the frightening experience. And unlike us, they know what it feels like to be sick, unable to have your family at your side.
They are the ones who started helping the mother and her baby while the medical team was suiting up. I watched as Chantal, a survivor who is also a nurse, began to carefully unwrap the baby in order to record its vital signs.
She placed the baby in the hanging scale, carefully supporting its head. But something looked awfully wrong.
“Lift the arm up and let go,” I said.
The arm fell back, completely limp. I looked at Chantal, then looked at the mother. She didn’t seem to have noticed anything. Or if she did, she didn’t show it. The baby was carefully wrapped up again and the mother sat back down, waiting. A few minutes later, the medical team showed up, all dressed in their bright yellow suits.
It was too late. The baby was dead.
Perhaps the disease had progressed too quickly. Or perhaps the mother delayed coming. People often do, and it’s hard to blame them. There are rumors that Ebola is a business run by foreigners just to make money, and that the vaccine is a kind of poison. Such misinformation pushes people to seek care from traditional healers in hopes of avoiding the Ebola Treatment Units. Sometimes they even flee when an Ebola response team’s armada of SUVs, flanked by armed police officers, speeds toward their village.
Attacks from armed groups here remain, after all, a regular affair, and the presidential elections contributed to the volatility. Certain areas remain out of reach to response teams, which means new cases of Ebola can go unnoticed.
But there is more we can — and must — do.
While promising vaccines and experimental treatments are rapidly being added to our arsenal, this technology is not a panacea. It is, after all, of little use if people don’t come to a treatment facility or come only when it’s too late. We must engage better with communities. We have to recognize where people are coming from and what their fears and expectations are in order to build trust.
We also need to reconsider some of our approaches to care. We could, for example, stop building huge testing and treatment centers in favor of small, more welcoming local structures. We could initially isolate and care for some patients in their own homes while their test results are pending. We could train members of the community, survivors especially, to help with that work. And we could consider new ways to safely allow select family members to be with loved ones during their time in isolation. Mothers of young patients, for instance, could be allowed to don protective gear for regular visits, so that they don’t have to feel like they’re abandoning their children in order to save their lives.
That way, maybe next time, we’ll be able to help that sick baby before it’s too late.